Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362
Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362
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DOI：
10.1080/09540121.2010.525617
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发表时间：
2011-01-01
影响因子：
1.7
通讯作者：
Williams, Paige L.
中科院分区：
文献类型：
--
作者：
Cohn, Susan E.;Jiang, Hongyu;Williams, Paige L.
在艾滋病毒感染人群的短期和横断面分析中，药物和酒精使用与较差的预后有关，但对坚持抗逆转录病毒治疗（ART）和晚期艾滋病临床结果的纵向影响尚未得到很好的描述。在一项多中心观察性研究中，我们评估了艾滋病患者自我报告的药物和酒精使用情况，并检查了它们与不依从、死亡或疾病进展的关系。我们将非依从性定义为在研究访视前48小时报告错过ART剂量。使用重复测量广义估计方程（GEE）模型评估药物使用与抗逆转录病毒治疗依从性之间的关系。通过Cox回归模型评估药物和酒精使用与艾滋病新诊断或死亡时间之间的关系，控制包括抗逆转录病毒治疗依从性在内的协变量。在1997年至1999年期间登记的643名参与者中，有39%的人报告曾使用可卡因，24%的人使用安非他明，10%的人使用海洛因。在研究随访期间，有9%的人使用可卡因，4%使用安非他明，1%使用海洛因。在GEE模型中，硬毒品（可卡因、安非他明或海洛因）使用者不坚持抗逆转录病毒治疗的几率高出2.1倍（p = 0.001），在Cox模型中，艾滋病进展或死亡的风险高出2.5倍（p = 0.04）。在随访期间控制不依从性后，使用硬性药物作为艾滋病进展或死亡的危险因素减弱（HR = 2.11, p = 0.08），但仍提示可能存在不依赖于依从性的危害机制。这项研究强调需要持续筛查和治疗患者的药物使用，作为正在进行的艾滋病毒护理的一部分。
Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997 and 1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p = 0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p = 0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR = 2.11, p = 0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care.